| Subject: Re: Federalizing Medicaid |
Author:
krz
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Date Posted: 10/15/04 9:55:48am
In reply to:
pjk
's message, "Re: Federalizing Medicaid" on 10/15/04 8:39:10am
I read that Kerry
>was going to phase out some three letter acronym that
>began with a "D" like "DHS" or something.
Was it the DHFS? - Department of Health and Family Services who typically is the intermediary in the provision of Medicaid services and sets the state regulations (and interpretation of those regs) for providers.
>
> What seems
>certain though is that without bipartisan work,
>without some sort of visionary push, we're headed for
>a disaster - all of us save the very wealthy.
I'm in full agreement here. Although I think the wealthy will have their challenge as well since much of the issue of health in this country is self-inflicted.
I don't
>think Kerry has an extraordinary vision for health
>care, but I can't get away from thinking that the idea
>that the more people you get to share the risk, the
>better the insurance program. As well, money spent up
>front pays back many fold in the future when it comes
>to health. (i.e. eventually we pay... more in the
>emergency room/ less with regular care).
I agree with the spread the risk mode - the challenge in my mind is not in the issue of ER care - but in the issue of chronic disease management which is a dual responsibility of government and the American people. What I haven't heard from either camp is 'here's what we'll do, now here's your obligation'. Give me my insulin, while allowing me to remain an overweight couch potato.
Whatever the
>merits or demerits of socialized medical programs, we
>need someone who can get us past the reactionary
>rhetoric so often found in republican circles that it
>is some caricature of Soviet long lines and so forth
>and get the best minds working on some kind of
>overhaul, some sort of "American" system that shares
>the best aspects of France & Canada without throwing
>out the baby with the bath water.
The reactionary rhetoric goes both ways, although kudo's to Clinton for starting the discussion on his watch. Shame on him for putting Hillary in charge - from the cheap seats I think she used it more as a mandate than as an opportunity to begin discussion. It took many years for Medicare to come along - changing to some nationalized health care will take even more.
The problem both with France and Canada is that they have a type of 'rationing' - essentially created through wait lists for elective procedures. Survive the wait list, you're generally considered a good risk (that's a little oversimplified obviously). What happens in these cultures is that those with money to receive services elsewhere, do. My personal opinion is that we would have difficulty implementing this in the US because most would receive coverage less than what they are used to, but quite adequate to address the majority of the health needs of the country. I'm not real sure our country is ready to move in that direction.
Since 'asides' are so fun for me on this discussion, another...
I recently asked the members of the support group that I run in conjunction with the pro bono clinic how much they would be willing to pay out of pocket to join a health club that would be tailored to meet the needs of individuals with disabilities (correct equipment, supervision, support, etc...) - the answer? $10/month. (They all have cable - I asked that too.) This is a perspective inconsistent with our national ability to provide services that will directly hit whichever camp chooses to take this issue on. I don't envy them their fight, but expect to join in.
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